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General NPI Number Information
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NPI Number | 1891963765
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Entity Type | Organization
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Legal Business Name | BACK PAIN SOLUTIONS INC.
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 808 DIAMOND ST
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City | BERLIN
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State | PA
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Zip | 15530-1539
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Country | US
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Telephone | 181-426-7830
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Fax |
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Provider Business Mailing Address
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Address Line | 808 DIAMOND ST
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City | BERLIN
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State | PA
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Zip | 15530-1539
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Country | US
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Telephone | 181-426-7830
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JAY MICHAEL KENNNEDY
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Credential | D.C.
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Telephone | 814-267-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | DC003949L
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License Number State | PA
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